Five Lesser-Known Psychedelic Harms and How to Reduce Risks
Having open and honest discussions about the full range of psychedelic risks is a critical part of how our field must grow and mature. Sparking such discussions also happens to be a critical part of our mission at Fireside Project.
We’ve already written about Hallucinogen Persisting Perception Disorder (internal link opportunity). Today, we explore five such lesser-known risks: Psychedelic Iatrogenic Structural Dissociation (PISD), Ketamine Bladder Syndrome, “Frog Face” from Kambo, Cannabinoid Hyperemesis Syndrome, and Wood Lover’s Paralysis. We hope this discussion sparks and deepens the conversation about the complex consequences these powerful medicines can have.
The good news is that Fireside Project can support you as you navigate and heal from potential harms. Our Psychedelic Hotline provides free support to people during and after psychedelic experiences. And our Fireside-Certified Psychedelic Coaching program provides long-term support, which includes harm reduction education.
Psychedelic Iatrogenic Structural Dissociation (PISD): Facilitator-Related Risks
What it is:
PISD is the idea that psychedelic treatment itself—when administered in a substandard container, without proper preparation or integration, by people with inadequate training or supervision, and/or when boundary violations occur—can cause new structural dissociation or worsen existing trauma-related dissociation.
The word “iatrogenic” means caused by treatment itself—in other words, harm that results not from the medicine, but from the way the medicine is administered.
PISD can happen when:
A guide encourages premature confrontation of traumatic material
Strong suggestion, spiritual bypassing, or imposing an interpretive framework overrides the client’s own meaning-making
Boundary violations or inappropriate interventions fracture trust and increase dissociation
Why it matters:
Psychedelics are powerful tools with radical healing potential. But like any powerful tool, they can cause harm if not used in accordance with the highest standard. PISD can happen when those standards are not followed, causing the psyche to defend itself by splitting further. At Fireside, we like to say that, with psychedelics, the veil between healing and harming is at its thinnest.
Harm-reduction practices:
Read: 10 Warning Signs When Selecting a Psychedelic Facilitator and Questions to Discuss with a Prospective Psychedelic Facilitator.
Seek professional support. Psychedelic.support has a list of therapists who specialize in psychedelic care.
If you think you’ve been harmed by unethical facilitator conduct, consider reaching out to NEST, which offers services to survivors.
Ketamine Bladder Syndrome: Long-Term Ketamine Use Risk
What it is:
Long-term or high-dose ketamine usage—especially outside controlled clinical settings—can lead to ketamine-induced cystitis, also known as ketamine bladder syndrome. Symptoms include persistent urinary urgency, painful urination, and bladder inflammation that, in severe cases, may demand medical intervention.
Why it should be on your radar:
As ketamine gains traction for both therapeutic and recreational use, the urotoxic potential is often underemphasized. While short-term, medically supervised use typically carries low risk, repeated unsupervised use, especially at higher doses, can lead to cumulative injury.
Harm-reduction strategies:
Monitor urinary function and be alert to changes in frequency, pain, or urgency.
Stay hydrated—though it doesn’t eliminate risk, it supports urinary tract health.
Reduce dosage or frequency if symptoms emerge, and consult medical professionals early—this is not a psychedelics-only issue.
In therapeutic contexts, providers should screen for prior use and educate clients on potential uro-physiological harms.
“Frog Face” from Kambo: Understanding Temporary Facial Swelling
What it is:
“Frog Face” describes a temporary and visible facial swelling or puffiness following Kambo ceremonies (the use of secretions from the Phyllomedusa bicolor frog). The phenomenon—likely related to allergic reaction, histamine release, or fluid shifts—results in a puffed, sometimes mask-like appearance.
Why it matters:
Though often benign and transient, “Frog Face” can be unsettling and may indicate a broader systemic reaction. It’s under-mapped, meaning many casual observers may dismiss it or be unnecessarily alarmed.
Harm-reduction practices:
Kambo facilitators should inform participants about this possible effect, emphasizing its usual short-lived nature (typically resolving in hours).
Before the ritual, assess for known allergies or sensitivities, and keep antihistamines or cold compresses on hand.
If swelling persists, is painful, or is accompanied by breathing or throat concerns, seek medical attention promptly—it may signal a more serious reaction like angioedema.
Cannabinoid Hyperemesis Syndrome: Risks of Heavy Cannabis Use
What it is:
While cannabis is often perceived as a soothing and therapeutic substance, heavy and prolonged use can sometimes trigger a paradoxical condition known as Cannabinoid Hyperemesis Syndrome (CHS). People with CHS experience cyclical bouts of intense nausea, vomiting, and abdominal pain that can be so severe it requires emergency medical care.
Harm-reduction practices:
The hallmark sign of CHS is a compulsion to take very hot showers or baths, which temporarily relieve symptoms by affecting the body’s thermoregulatory system. But the only lasting “cure” is reducing or stopping cannabis use altogether—a step that can be difficult for those who rely on it for pain management, anxiety, or other conditions.
For psychedelic practitioners and support networks, awareness of CHS is critical, especially in communities where cannabis is commonly integrated into spiritual or therapeutic practices. Recognizing the symptoms early can save someone from prolonged suffering and repeated, confusing trips to the ER.
Wood Lover’s Paralysis: Psilocybin Mushroom Risk
What it is:
Another lesser-known harm arises from certain psilocybin-containing mushrooms that grow on wood substrates (such as Psilocybe azurescens and Psilocybe cyanescens). In rare cases, people who consume these species report a sudden onset of temporary paralysis or muscle weakness, a phenomenon known as Wood Lover’s Paralysis.
The condition is poorly understood, with no clear mechanism identified. The paralysis can last for hours, leaving individuals unable to move or speak even while fully conscious—a profoundly frightening experience if one is unprepared.
Harm-Reduction Practices:
Given the rising popularity of wild foraging and the romanticization of “potent wood-loving mushrooms,” it’s important for people to be aware of this risk. For those who are new to mushroom use, cultivating a deeper knowledge of species differences—and ideally avoiding unsupervised foraging—can reduce the likelihood of encountering this unsettling effect.
Conclusion
The winds of psychedelic exploration carry potential for profound healing—and also for subtle, less visible harms. Awareness and education are powerful allies. By naming and normalizing known risks, we empower individuals, facilitators, and communities to approach psychedelic work with fuller awareness and care.
We’d love to hear from you: have you or someone you know encountered any of these? How did you make sense of it—and what helped? Leave a comment or, if you’re seeking integration support, reach out to our Psychedelic Hotline or schedule a session with a Fireside-Certified Psychedelic Coach.
FAQs on Psychedelic Harms and Safety
What are some lesser-known psychedelic risks?
Beyond widely discussed conditions like HPPD, lesser-known harms include Psychedelic Iatrogenic Structural Dissociation, ketamine bladder syndrome, Kambo “frog face,” cannabinoid hyperemesis syndrome, and wood lover’s paralysis.
How can I reduce risks when using psychedelics?
Preparation, ethical facilitation, medical awareness, and post-experience integration are key harm reduction strategies. Choosing a trained facilitator and seeking ongoing support also help.
Is ketamine safe for long-term use?
Short-term, medically supervised use generally carries low risk. However, repeated recreational or unsupervised use can lead to ketamine-induced bladder syndrome and other health issues.
What should I do if I think I have Cannabinoid Hyperemesis Syndrome (CHS)?
If you experience repeated nausea, vomiting, and relief from hot showers, consult a doctor immediately. Reducing or stopping cannabis use is the only lasting way to resolve CHS.
Where can I find support for psychedelic harm reduction?
Fireside Project’s Psychedelic Hotline and coaching services provide free and long-term support, including education on psychedelic safety and harm reduction.
